1. Hybrid Repair of Kommerell’s Diverticulum
Jahanzaib Idrees MD, Suresh Keshavamurthy MD, Sreekumar Subramanian MD, Daniel G. Clair MD, Lars G. Svensson MD, Eric E. Roselli MD
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Heart and Vascular Institute 1

2. Kommerrel’s Diverticulum
Frequently co-exists with aberrant subclavian artery & right sided aortic arch
Ligamentum Arteriosum
Completing Vascular ring
Right sided
Aortic Arch

3. Objectives To describe hybrid repair techniques
To evaluate clinical outcomes

4. Patients N=10 August 2005 to October 2010 Mean Age 57 ± 25
Elephant Trunk with Endo completion N=4
Frozen Elephant Trunk N=3
TEVAR with Cervical Debranching N=3

5. Elephant Trunk With Endo Completion
Stage I
Stage I I

6. + Ascending Subclavian Bypass
Frozen Elephant Trunk
N=3
Stentgraft delivered antegrade; sutured proximally
Posterior view; subclavian coiled
+ Ascending Subclavian Bypass
Ligamentum divided

7. TEVAR with Cervical Debranching
Right Carotid subclavian bypass
Left Carotid subclavian bypass
Stent Graft

8. Subclavian Revascularization
C-S Bypass
Asc-S Bypass
Unilateral (N=6) 4 2
Bilateral (N=4) 3 1
Timing N
Preoperative 4
Intraoperative 3
Postoperative

9. Results No Mortality 1 Stroke
Post TEVAR, mild dysarthria and unilateral leg weakness
2 Type II endoleaks
1 requiring Subclavian embolization
No paraplegia
No Respiratory failure
No Renal failure
No Reoperation for bleeding

10. Conclusions
Hybrid repair of Kommerell’s diverticulum is safe and effective.
Type of intervention is based on patient’s anatomy and co-morbid conditions.